Early Kangaroo Mother Care in Preterm Infants: Is it Safe?
Bedetti L1, Bertoncelli N2, Lugli L2, Spaggiari E2, Cuomo G2, Cosimo AC2, Di Giuseppe M2, Ierardi G2, Lelli T2, Muzzi V2, Paglia M2,
Pezzuti L2, Piccolo A2, Sabbioni F2, Torcetta F2, Torelli P2, Lucaccioni L2, Ferrari F3, Berardi A3
1
PhD in Clinical and Experimental Medicine, University of Modena and Reggio Emilia – Italy
2
Department of Mother's and Child's Health, Neonatal Intensive Care Unit, AOU Modena – Italy
3
University of Modena and Reggio Emilia - Italy
Aims
Kangaroo mother care (KMC) was first described in 1978 by
Dr. Edgar Rey Sanabria as an alternative to the incubator in low-
resource countries. Over time this practice has been extended to
high income countries because it is effective in improving infant
growth and neurodevelopment, especially in preterm infants.
However, KMC is frequently feared by health care professionals,
particularly nurses who are in charge to support infants and
parents during the procedure. The aim of this study is to
demonstrate the safety of early KMC in preterm infants.
Methods
A prospective observational monocentric study was performed.
Infants born between June 2018 and June 2020, with gestational
age <33 weeks and birth weight <2000 grams were monitored
while having KMC during the first three weeks of life. Infants
with necrotizing enterocolitis, sepsis, congenital malformations,
receiving mechanical ventilation or with more than five apneic
episodes in the hour prior to KMC were excluded. Continuous
oxygen saturation (SaO2), heart rate (HR) and respiratory
rate (RR) as well as body temperature were registered during
KMC, and in the hour prior to KMC. The minimum duration
of the KMC session was 90 minutes. Information regarding
post conceptional age, weight, respiratory support, presence of
central venous catheter and onset of sepsis within 72 hours after
the procedure was collected. Two physicians, blinded to patient
conditions and period of analysis (before or during KMC)
evaluated desaturation episodes (SaO2 <85%, >15 seconds),
bradycardia (HR <100, >15 seconds), and apnea (pause in
breathing > 20 seconds associated with desaturation or/and
bradycardia). Wilcoxon signed-rank test was used for statistical
analysis. The study was approved by the Local Ethics Committee.
Developmental
Observer
A semi-annual publication of the NIDCAP Federation International © 2021. The statements and
opinions contained in this newsletter are solely those of the individual authors and contributors
and not necessarily of the NIDCAP Federation International. Articles from the Developmental
Observer, duly acknowledged, may be reprinted with permission. Please contact us at:
developmentalobserver@nidcap.org.
Senior Editor Kaye Spence AM
Associate Editors Diane Ballweg, APRN, CCNS, Deborah Buehler, PhD, Sandra Kosta, BA
gretchen Lawhon, PhD, RN, FAAN, Maria Lopez Maestro, MD
Associate Editor Jeffrey R. Alberts, PhD
for Science
Column Editor Debra Paul OTR/L
2 • 2021 • Developmental Observer
DOI: 10.14434/do.v14i1.31808
Results
We analyzed 83 episodes of KMC for a total of 38 infants.
Mean gestational age at birth was 29 weeks (range 23-33 weeks).
Mean post conceptional age, days of life and weight at KMC were
31 weeks (range 25-34 weeks), 10 days (range 1-20 days) and
1131 grams (631-2206) respectively. Seventy-seven percent of
patients were on respiratory support and 47% of patients had a
central venous catheter (umbilical catheter or peripherally inserted
central catheter) during KMC. Total duration of desaturation, total
duration of bradycardia, number of apnea episodes and body tem-
perature were not statistically different during KMC episode and
the hour prior to KMC. No adverse events related to catheters were
reported. One session was followed by sepsis.
Conclusion
KMC plays a key role in the care of the preterm infants, and
deserves to be increasingly offered to infants and to their
families. The results of this study should reassure health care
professionals, highlighting the safety of the procedure in preterm
infants and the possibility to perform KMC in an intensive care
setting in the first weeks of life.
References:
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S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis.
Pediatrics. 2016 Jan;137(1). DOI: https://doi.org/10.1542/peds.2015-2238
2. Shattnawi KK, Al-Ali N, Alnuaimi K. Neonatal nurses' knowledge and beliefs about kangaroo
mother care in neonatal intensive care units: A descriptive, cross-sectional study. Nursing and
Health Sciences. 2019 Sep;21(3):352-358. DOI: 10.1111/nhs.12605
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Mother Care in Preterm Infants: Clinical Characteristics and Safety of Kangaroo Mother Care
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5. Carbasse A, Kracher S, Hausser M, Langlet C, Escande B, Donato L, Astruc D, Kuhn P.
Safety and Effectiveness of Skin-to-Skin Contact in the NICU to Support Neurodevelopment
in Vulnerable Preterm Infants. Journal of Perinatal and Neonatal Nursing. 2013 Jul-Sep;27
(3):255-62. DOI: 10.1097/JPN.0b013e31829dc349
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